Before answering the discussion questions, please read the Module 1 Content Guide and the short articles from the National Child Traumatic Stress Network (NCTSN), one of the leading sources of the most cu
ent thinking about childhood trauma. Also, take a look at the info-graphic that nicely summarizes a lot of information from the National Child Traumatic Stress Initiative.
Readings
· National Child Traumatic Stress Network. (n.d.) What is a traumatic event?
· National Child Traumatic Stress Network. (2012). The 12 Core Concepts: Concepts for Understanding Traumatic Stress Responses in Children and Families.
· National Child Traumatic Stress Network. (n.d.) Populations at Risk.
· National Child Traumatic Stress Initiative. (n.d.) Understanding child trauma. Retrieved from SAMHSA.gov.
Once you've read the above, answer the following:
1. What are your questions about how a child's reactions to a traumatic event are influenced by "child factors", "family factors" and "trauma factors"? (See content guide)
2. What are your thoughts about why two children might react to the same traumatic event differently? Give an example, please.
3. What are some responses to trauma you've seen in children? Give an example, please, protecting the privacy of any child you describe.
4. Looking back, do you think you may have misinterpreted some child behavior as "bad behavior" when possibly it was a reaction to trauma? If so, please give an example.
5. What is one of the most important new insights you've had about what is unique about child trauma compared to other childhood difficulties such as loss or mental illness?
6. What are your continuing questions about what makes traumatic events difficult for children?
An Introduction
Childhood trauma is a
oad and complex topic. In this first module, we will take an overview of how child trauma is defined and what distinguishes it from other painful things that can happen in a child’s life.
We will look at the types of childhood traumatic events, such as child abuse and neglect, car accidents, natural disaster, and invasive medical procedures.
We will look at the factors that affect a child’s experience of a traumatic event – either to protect the child from long-lasting effects, or to increase the risk of long-last effects of the traumatic event.
We will take our first look at the range of physical and emotional and behavioral responses children often have to traumatic events – both short term reactions, and the longer-term reactions such as Post Traumatic Stress Syndrome (PTSD) and Child Traumatic Stress.
And lastly, we will look at how often traumatic events happen for children in the U.S. and of those children, how many develop long-term negative effects.
I. Four important definitions
First off, let’s start with four important definitions.
A. “Trauma”:
The DSM-5 definition of trauma requires “actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association, 2013).
Stressful events not involving an immediate threat to life or physical injury such as psychosocial stressors (e.g., divorce or job loss) are not considered trauma in this definition (Pai, Suris, & North, 2017).
We distinguish trauma from other kinds of bad things that happen to people because in trauma it is the credible threat of loss of life or physical well-being that sets off the unique physiological reactions in trauma. While the divorce of a child’s parents or death of a relative may be ultimately more painful and impactful on a child’s life than the trauma of a car accident or an assault, it is the latter that qualifies as a “trauma” because they are threats to the physical well-being of the child.
B. “Traumatic event”:
A traumatic event is a frightening, dangerous, or violent event that poses a threat to a child’s life or bodily integrity. Witnessing a traumatic event that threatens life or physical security of a loved one can also be traumatic. This is particularly important for young children as their sense of safety depends on the perceived safety of their attachment figures.
Traumatic experiences can initiate strong emotions and physical reactions that can persist long after the event. Children may feel te
or, helplessness, or fear, as well as physiological reactions such as heart pounding, vomiting, or loss of bowel or bladder control. Children who experience an inability to protect themselves or who lacked protection from others to avoid the consequences of the traumatic experience may also feel overwhelmed by the intensity of physical and emotional responses (NCTSN, 2012).
C. “Traumatic exposure”:
A traumatic exposure is a confrontation with actual or threatened death, serious injury or other threat to physical integrity (APA, DSM-5, 2013).
D. “Reactions to trauma”:
The focus of much of our work as counselors and parents is how a child reacts to a traumatic event. There are short-term physiological reactions such as neurological and physiological changes, and emotional reactions such as fear, shock, and anger. Some of these initial reactions resolve fairly quickly, but other reactions make a longer term impact on the child’s
ain and behavior, such as child traumatic stress or PTSD.
II. Types and characteristics of traumatic events:
A. There are many types of potentially traumatic events:
· Abuse (physical, sexual, or emotional)
· Neglect
· Effects of poverty (such as homelessness or not having enough to eat)
· Being separated from loved ones
· Bullying
· Witnessing harm to a loved one or pet (e.g., domestic or community violence)
· Natural disasters or accidents
· Unpredictable parental behavior due to addiction or mental illness
· For many children, being in the child welfare system becomes another traumatic event. This is true of the child’s first separation from his or her home and family, as well as any additional placements (Child Welfare Information Gateway, n.d.).
B. Traumatic events vary from each other in a number of ways, and some traumatic events may be much more harmful than others, of course. These characteristics of a traumatic event affect how impactful the event may be:
· The severity of the event: How badly was the child or other person hurt? Was someone hospitalized? Were the police involved? Were children separated from caregivers? Did a friend or family member die?
· The child’s proximity to the event: Was the child present during the event or did they hear about it, see it on TV, etc. Did it happen to themselves or close one, or another person?
· The frequency of the event: How often it happened, how predictable was the event
· The degree to which the event impacted the child’s entire life, called the “immersiveness” of the event.
· Whether the event was caused by a person (especially a close person) versus a natural disaster (NCTSN, n.d.).
III. Other factors that impact a child’s experience of trauma
In addition to “trauma factors” such as severity and proximity, noted previously, “child factors” and “community factors” impact the child’s experience of trauma.
A. Child factors
Age: Young children with rudimentary cognitive/language and coping skills have a harder time handling traumatic events – without a lot of support – than more mature children.
Individual resources, such as intelligence, physical health, self-esteem can protect and child from the adverse effects and help them cope with a traumatic event. (Protective factor)
Prior history of mental health issues can make a child more vulnerable. (Risk factor)
Past trauma can make a child more vulnerable and/or more resilient to a cu
ent traumatic event. If the child has worked through a prior trauma, she/he may have learned coping skills. (Protective factor) On the other hand, if a prior trauma is still an open wound, the child may have a harder time managing a new trauma exposure. (Risk factor)
Traits of temperament such as sensitivity and rigidity, or stamina and heartiness may shape how a child reacts to trauma. (Protective or Risk factors)
***The child’s perception of the danger in the event and the amount of fear the child felt at the time are significant risk factors for harm from the event.
B. Family and community factors
Critical to a child’s reaction to a traumatic event are the responses of caregivers to the traumatic event and/or to the child’s reactions to the event. If the child’s family is blaming, distrusts the child, or avoids the reality of the trauma exposure, the child is at more risk for on-going harm. Whereas if the family supports and accepts the child’s reactions and the reality of the exposure, the child has stronger protection against sustained harm.
Responsive, helpful relationships with family and caregivers (protective factors).
Supportive school and community environment (protective factors).
Financial supports for the family, and/or child mental health resources in the community (protective factors).
Lack of community supports in situations of poverty, forced migration, wartime. (Risk factors) (NCTSN, n.d.; NCTSI, n.d.).
C. The cu
ent thinking is that PTSD (or long-term harm) is caused by multiple factors, systemic interactions among them, and a process of such interactions among factors that unfolds over time. There is no single or linear causation of PTSD that you can point to. For example, a child may have initial family support after a house fire, but over time, the parents may become depressed and isolated and the support will turn to avoidance. Or the converse, a child may feel completely isolated about a frightening bullying situation, but a parent or teacher can uncover the abuse and begin to protect and support the child (Alisic et al, 2011; Pat-Horenczyk et al, 2009).
IV. Overview of children’s reactions to traumatic events:
(We will look more closely at the child’s reactions to traumatic events in Modules 4 & 5)
· Immediate reactions: shock, overwhelm, dissociation, te
or (Levine & Kline, 2006, p XXXXXXXXXX)
· Short-term reactions: temporary and not severe versions of symptoms below
· Longer-term reactions:
1. In the cu
ent DSM-5, PTSD applies to children over the age of 6 and adults:
· Criteria one: exposure to a traumatic event
· Criteria two: intrusive symptoms
· Criteria three: avoidance of stimuli related to exposure
· Criteria four: negative thoughts or feelings
· Criteria five: hyper-arousal and reactivity
(APA, 2013 cited in SAMHSA, 2014)
2. In the cu
ent DSM-5, children under 6 did get a separate subtype of PTSD in the DSM-5: the section is titled “Posttraumatic Stress Disorder for Children 6 Years and Younger”. It lists the same set of symptom criteria as the PTSD diagnosis above, but the symptoms are described behaviorally rather than psychologically, and there are fewer symptoms in each criteria. This is because very young children don’t have the introspection or language to express their distress in language as older children and adults do.
3. In the cu
ent DSM-5, Acute Stress Disorders list the same criteria as the PTSD criteria above, but fewer criteria are required to meet the diagnosis.
4. Child Traumatic Stress is defined this way:
“…intense and ongoing emotional upset,
depressive symptoms and anxiety,
ehavioral changes,
difficulties with self-regulation,
problems relating to others and forming attachments,
egression and loss of previously acquired skills,
attention and academic difficulties,
nightmares,
difficulty sleeping and eating,
and physical symptoms such as aches and pains” (National Child Traumatic Stress Network, n.d.).
V. Incidence/prevalence:
Child trauma occurs more than you think:
· More than TWO-THIRDS OF CHILDREN reported at least 1 traumatic event by age 16.
· The national average of child abuse and neglect victims in 2013 was 679,000, or 9.1 victims per 1,000 children.
· Each year, the number of youth requiring hospital treatment for physical assault-related injuries would fill EVERY SEAT IN 9 STADIUMS.
· More than half of U.S. families have been affected by some type of disaster (54%, NCTSI, n.d.).
Not every child who is exposed to a traumatic event will develop long-term serious reactions, such as PTSD, in fact approximately one in three will. Estimates vary, but a ballpark number derived from a review of many studies is that 2 of 3 kids exposed DO NOT develop PTSD (Fletcher, 2003).
Not all outcomes of trauma exposure are negative. As with adults, children may experience posttraumatic growth: closer to their families, stronger, spiritual awareness, appreciation of life, and new possibilities (Laceulle et al, XXXXXXXXXXMost children can get through a painful time, but then it is done and they are often stronger for it.
The severity of the child’s reactions to a traumatic event are shaped by the characteristics of the traumatic event itself, and the characteristics that the child
ings to the situation, and the characteristics of the child’s family and community environment. (See above)
Readings/References for this module:
Alisic, E., Jongmans, M. J., van Wesel, F., & Kleber, R. J XXXXXXXXXXBuilding child trauma theory from longitudinal studies: A meta-analysis. Clinical Psychology Review, 31(5), XXXXXXXXXXdoi:10.1016/j.cpr XXXXXXXXXX
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Arlington, VA, USA, 2013.
Child Welfare Information Gateway. (n.d.). "Parenting a child who has experienced trauma." Retrieved from the Children's Bureau website, childwelfare.gov. https:
www.childwelfare.gov/pubPDFs/child-trauma.pdf
Fletcher, K. E XXXXXXXXXXChildhood posttraumatic stress disorder. In E. J. Mash, & R. A. Barkley (Eds.), Child psychopathology, 2nd Ed., pp XXXXXXXXXXNew York: Guilford Press.
Laceulle, O. M., Kleber, R. J., & Alisic, E XXXXXXXXXXChildren’s Experience of Posttraumatic Growth: Distinguishing General from Domain-Specific Co
elates. Plos ONE, 10(12), 1-12. doi:10.1371/journal.pone XXXXXXXXXX
Levine, P.